HealthWatch runs every other week as a regular Gazette feature where medical journalist Evra Taylor Levy and emergency physician Eddy Lang help make sense of sometimes contradictory medical research.

In the world of medicine, many diseases and conditions are clear-cut and relatively easy to diagnose and treat. Unfortunately, fibromyalgia isn’t one of these, but the ambiguity of the symptoms doesn’t diminish the very real pain its sufferers experience. This week’s HealthWatch takes a closer look at this debilitating illness and some recent research that suggests relief might be found at the pool.

What is fibromyalgia?

Fibromyalgia is an increasingly common chronic condition that has stricken roughly one million Canadians. It afflicts women at least four times more often than men and often occurs after the age of 50, sometimes worsening with age.

It affects the muscles and tendons and ligaments, which connect muscles to bones. Its main symptoms are fatigue, muscle spasms, weakness, stiffness, and pain in the joints and muscles in areas of the body known as trigger points or tender points. Some of these are located in the neck, shoulder, back and thighs and can be extremely sensitive to even light touch. Rheumatologists, who are the doctors specialized in the care of this condition, make the diagnosis in part by probing these points: a painful reaction is often a sign of fibromyalgia.

There isn’t one definitive cause of fibromyalgia, but physical trauma, like a car accident, can trigger it.

What is its impact on daily lives?

The effects of fibromyalgia are more than just physical; it also takes a huge emotional toll. Insomnia is common, along with the depression brought on by chronic pain and the social isolation of not being able to participate in one’s usual activities. Loss of independence is also a factor. Time off work can have an enormous financial impact on fibromyalgia sufferers – as well as on society as a whole. A recent U.S. study of associated health-care expenditures reported virtually the same very high cost for fibromyalgia as for osteoarthritis, even though the latter is much more common.

How is it treated?

There’s no cure for fibromyalgia, so the focus is on improving quality of life through symptom relief.

Antidepressants are sometimes prescribed – they boost serotonin levels, acting as a mood-enhancer. Injections of painkillers or steroids in trigger points can also reduce pain.

Walking or riding a stationary bike will improve endurance and boost energy, and low-impact aerobics can be useful if one’s condition allows.

The study

Cost-utility of an eight-month aquatic training for women with fibromyalgia: a randomized controlled clinical trial, by Narcis Gusi, Arthritis Research & Therapy, February 2008.

Why are there possible advantages to a pool-based program?

When immersed in water to the level of the upper abdomen, a woman carries less than one-third of her real weight, thus enabling movements and promoting flexibility that might not be possible on land. Warm water is also immediately soothing to painful limbs. So for someone with fibromyalgia, exercising in a pool is both more feasible and more likely to result in benefits.

What kind of study was this?

Investigators in Spain and Portugal recruited 34 women with fibromyalgia and randomly assigned them to two groups. The 17 women in the study group underwent hour-long, supervised exercise training sessions

(hydrotherapy) in a swimming pool for eight months. The 17 women in the comparison group performed their usual activities.

What were the main findings?

Patients in the swimming program had reduced pain, as well as increased strength, flexibility and endurance. They also had improved sleep, better mood and increased confidence in being able to perform their daily activities.

These researchers were also interested in the economics of this type of program. They conducted an analysis to determine whether the costs of an aquatic program are offset by the reduced health-care expenses (medications and doctor visits) and increased productivity through their ability to return to gainful employment. Here again, the authors concluded that hydrotherapy is beneficial and cost-effective. This is, of course, dependent on the availability of such a program, guided by a qualified instructor, access to a swimming pool, and whether registration is sufficient to make the program viable.

Are there any concerns with this study?

Although this is a small study, it’s worth noting that hydrotherapy has been researched in eight other studies, all with fairly consistent results. One caveat is that these studies also suggest that the benefits partially fade after program completion and that either longer enrolment periods or long-term commitments might be necessary for sustained benefit.

One lingering concern is that since the patients in the comparison group did not interact socially with fellow

fibromyalgia patients as did the ones in the study’s exercise group, many of the benefits noted in this study may have resulted from the social support received, instead of warm water and exercise. An earlier study, which gathered fibromyalgia patients in warm water baths without exercise in the control group, showed that the addition of exercise mediated the benefits seen.

So what should fibromyalgia patients do?

Unlike medications, which generally carry some risk of side effects, a warm water aqua-fitness program is unlikely to be harmful. The benefits of a regular exercise program, pool-based or not, have a clear-cut track record for improving one’s general health. So if possible, this approach should be considered seriously in patients who have even a moderate case of fibromyalgia. Important considerations are that this study demonstrated positive results after an eight-month program in a pool set at 37 degrees. It’s possible that shorter programs in cooler water might not work or work as well. A number of Montreal facilities offer pool exercise programs for arthritis and fibromyalgia sufferers.

The material provided in HealthWatch is designed for general educational purposes only and does not pertain to individual cases. The information included should not replace necessary medical consultations with your own doctor or medical professional.

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